1. What will the Pre-anesthetic Evaluation
involve?
Your care begins with a Pre-anesthetic Evaluation in which an
anesthesia care professional will ask you important medical history
questions and perform a brief physical exam to learn more about you
prior to your visit to the operating room. This process may also
include laboratory tests, electrocardiogram, and/or chest x-ray
examinations. Appropriate medical consultants may also be scheduled
at this time.
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2. Why can’t I have anything to eat or drink
before surgery?
While anesthetized, people can vomit or passively regurgitate
the contents of their stomachs into their airway. The normal gag
reflexes that protect their airways are inactive under anesthesia
and these fluids and partly digested solids can get into the trachea
and lungs causing a severe pneumonia which can be fatal. The most
important step in preventing this complication is making sure
patients have empty stomachs before beginning an anesthetic. In
general, we follow the accepted guidelines of no solid foods for 8
hours prior to an anesthetic. We usually allow clear liquids up to 2
hours prior to anesthesia induction. Newer research has shown that,
in people with normal stomach functions, clear liquids readily pass
through the stomach within two to three hours and, according to some
studies, may lower the acid content compared to a strict fast. Also,
most patients with normal digestive systems empty their stomachs of
solids within six hours.
However, it is important to understand that these guidelines
don't apply to patients who have conditions that are known to delay
stomach emptying: diabetics, peptic ulcer disease, morbid obesity,
and those involved in a trauma, among others. Your anesthesiologist
is ultimately responsible for your safety during surgery; their
assessment of the situation and judgment of how to proceed are the
best for your specific case.
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3. What should I do about taking my regular
medicines before surgery?
You should consult your anesthesiologist and surgeon on which of
your regular medicines to take prior to surgery. These physicians
may also consult your regular doctor. In general, you will be
advised to take most of the maintenance medicines that you are on.
There are several types of medicines that you may be advised to hold
for a period of time prior to surgery. These may include “blood
thinners” such as coumadin or plavix.
In addition, it is very important to inform your care providers of
any non-prescribed medicines, “over-the-counter” medicines, or
herbal medicines/remedies that you are taking. Excessive or frequent
alcohol use is also important information for your physicians.
Finally, any use of illicit drugs like marijuana, cocaine, “crack”,
or “meth” needs to be reported to your Anesthesia Care Team. Even
though divulging this information may be embarrassing or
uncomfortable, some of these drugs can cause life-threatening
interactions with several of our anesthetic medications. Not
reporting use of these drugs can put your life at risk during an
anesthetic.
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4. What are the types of anesthesia?
In general, there are three broad types of anesthetic
methods: 1) monitored anesthesia care (“MAC”), 2) regional
anesthesia (a “block”) and 3) general anesthesia (“going to sleep”).
There are also combinations of these methods. It is very important
to realize that certain types of anesthetic methods may not be
appropriate for a particular surgery, a particular surgeon, or a
particular patient (please see “What type of anesthesia will be best
for me?”
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5. What is “MAC” anesthesia?
“MAC” are the initials for “Monitored Anesthesia Care”. Medicine
may be injected into the intravenous line to sedate you and make you
sleepy while the surgeon numbs the surgical site. You may recall
being in the operating room, but, if you hurt at all, more numbing
medicine and/or intravenous medicine will be administered to relieve
any discomfort. We are there to watch over your heart, blood
pressure, and breathing to make sure you are safe and comfortable.
Usually, if you feel you are too awake and would like additional
sleepy medication, we can provide this.
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6. What is “Regional Anesthesia”?
An area of the body that includes the surgical site is numbed
by placing medicines near nerves that supply that area. The skin
above the spot to be numbed is cleaned with an antiseptic and numbed
with a local anesthetic. Next, a needle is placed through the numbed
skin near the nerves we are trying to anesthetize -- either in the
epidural space, the spinal space, or those going to your arm or leg.
These nerve blocks usually will need to be performed with you
comfortably awake. You can be sedated prior to the block but we will
usually need to communicate with you to make sure we place the
needle in the correct place. After we know you are numb from our
medicine, we usually can get you as sleepy as you would like during
the surgery itself. A small sore spot around the injection area for
a day or two is common. The risks for spinal and epidural anesthesia
include a possible spinal headache which can be treated. Other very
rare risks include an infection called meningitis, and bleeding in
or around the spine or spinal cord. Although very unlikely, either
can result in the need for surgical treatment and can cause
permanent nerve damage. With any regional anesthesia technique it is
remotely possible to cause seizures and very rarely nerve damage.
Finally, we will not let you hurt. We always are ready to give you
general anesthesia if you are uncomfortable or anxious.
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7. What is “General Anesthesia”?
“General Anesthesia” is the term for an anesthetic that
involves “going to sleep”. An unconscious state is induced using
medicines through an intravenous catheter. Your skin will be
injected with numbing medicine prior to starting the IV catheter.
(Most children will have their IV started after they are asleep.)
After you are asleep a breathing tube or airway device may be placed
in your mouth or nose to help you breathe. This may cause a
scratchy, sore throat for a day or two after surgery. Without
preventative medicines given by your anesthesia team, on average
20-40% of patients having surgery get some degree of nausea or
vomiting. Some anesthesia drugs cause nausea, postoperative pain
medicine causes nausea, and some types of surgery themselves cause
nausea. Your anesthesiologist will attempt to prevent nausea and
vomiting where indicated and will aggressively treat either if they
occur. Rarely, teeth may be injured if placing the breathing tube is
difficult, or you bite wrong while asleep. Usually, you will wake up
somewhat sleepy in the recovery room.
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8. What type of anesthesia will be best for me?
The anesthesiologist will consider several factors when
choosing your anesthesia:
a) Your medical history & physical examination. The anesthesiologist
will consider other surgeries you have had and any conditions you
have (such as hypertension, coronary disease, emphysema, diabetes,
liver disease, or peripheral neuropathies as examples) which may
affect your anesthetic course. You also will be asked whether you
have had any allergic reactions to any anesthetics or medications or
whether any family members have had reactions to anesthetics.
b) The reason for your surgery and the type of surgery which may
determine the type of anesthetic type that is possible.
c) Your preference and the surgeon’s preference (if any) for the
type of anesthesia.
The ultimate decision of the type of anesthesia for your care will
depend upon a discussion with the anesthesiologist about your
anesthetic options. Some of these options may be limited by the type
of surgery or your health history. For those surgeries in which you
have a choice of anesthetics, the anesthesiologist will help you
decide which anesthetic will be best for you.
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9. Are there risks associated with anesthesia?
Like everything else we do in life, undergoing anesthesia involves some risk. These risks include, but are not limited to, nausea, vomiting, achy muscles, a sore throat, chipped teeth, allergic reaction to one of the medicines given, injury to or malfunction of major organs such as your heart, lungs or brain, or even death. The risk of something significant happening that cannot be handled by the care team is very small for someone in otherwise good health. This wonderful safety record is the result of a having highly trained professionals administering the anesthetic along with state of the art monitoring devices.
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10. What is “anesthesia recall”?
Anesthesia recall occurs when a patient undergoing general anesthesia for a procedure is conscious during some part of the operation and has memory of the incident. In general this is a very rare occurrence. There are several instances where awareness is more likely, but still rare. These include, trauma patients undergoing general anesthesia and patients undergoing general anesthesia for emergency caesarian section. In the past, patients undergoing general anesthesia for heart surgery were at an increased risk for awareness, but this risk has decreased with new techniques. For the general population, the risk of recall or awareness is very small.
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11. What about my medicine allergies?
It is important to discuss any allergies you may have with your anesthesiologist. Some of these medications may have cross reactions with medicines used for your anesthetic. Occasionally, the reactions you have had may not be true allergies, but common side effects of the medicine that can be treated, if that particular medicine is required. For example, itching is a side effect of some narcotic medicines. Other narcotic medicines may work with decreased itching, or maybe that narcotic medicine can be used (because it works so well on pain for a particular case) and the itching treated with another medicine.
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12. What is “Malignant Hyperthermia”?
Malignant Hyperthermia (MH) is a rare but life-threatening
condition that occurs approximately one in 50,000 anesthetics. It
takes its name from the high fever (up to 108 degrees) that is one
of the signs of the disease. MH is a genetically transmitted disease
although it can appear without any previous family history,
especially in patients with certain neuromuscular diseases like
muscular dystrophy. The basic event in MH is a “run-away” metabolism
of the body which can lead to cardiac collapse, brain injury, and
even death. The disease can be triggered in susceptible patients by
several commonly used anesthetic drugs.
The signs and symptoms of MH are often quite dramatic when it
occurs but fortunately there are established protocols and medicines
to quickly treat this syndrome if it does occur. It is also vitally
important to report a history of MH in the patient or patient’s
family members to the anesthesia team. This will allow them to use a
type of anesthesia that is not associated with triggering MH. If an
episode of MH occurs, the patient’s family will often be encouraged
to undergo testing to determine their potential risk of developing
the syndrome themselves.
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13. Will I have any sedation prior to going into
the operating room?
In most cases, you can receive sedation prior to going to the
operating room. This medicine will relax you and decrease your
anxiety for the trip back to the OR. It will not “knock you out.” It
is important though that all paperwork and consents are completed
and checked prior to you receiving sedation. In some cases, sedation
will not be given because it may interfere with your care prior to,
during or after the operation. Some plastic surgery cases require
the patient to stand and be “marked”. Sedation is usually held until
after this is done. In some neurosurgical or vascular operations,
sedation prior to the operation can linger on after the case and
interfere with neurological exams of the patient. In emergencies,
where the patient has not been fasting, sedation may be withheld to
protect the patient from vomiting the contents of the stomach into
the lungs.
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14. Will I be able to be with my child prior to
their going to surgery?
This is a practice that varies significantly among groups and facilities. There have been multiple studies which, in all, are inconclusive as to the benefits of parents being with their children at the induction of anesthesia. It is in our nature as parents to want to be supportive and protective of our children in these stressful times. The problem occurs when our need to support our child impacts on the anesthesiologist’s ability to care for the child during the induction of anesthesia. The anesthesiologists of ACMG have decided, based on a wide and varied practice experience, not to allow parents to accompany the child during induction. With the benefits to either the child or the parents in question, and the real possibility of interfering with the safe induction of anesthesia, we feel this is the most appropriate approach. Most children will receive a preoperative sedative by mouth prior to arriving in the receiving area. This medicine will make the child “loopy” but is not the anesthetic. This sedative also has amnestic properties, meaning that the child will most likely have little memory of the trip to the OR. You will accompany the child to the receiving area where you will meet the members of the Anesthesia Care Team (ACT) who will discuss the anesthetic plan with you and answer any questions you may have. The child will then be escorted to the OR by members of the ACT and the OR team.
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15. How soon will I be able to see my child
after surgery is completed?
After the operation, the child is usually taken to the post anesthesia care unit (PACU) or “recovery room”. While in the PACU, the child will finish recovering from the anesthetic, under the watchful eye of a specially trained RN who is supervised by the staff anesthesiologist. Once the patient has stabilized and has his/her pain addressed, he/she will be brought back to you in the room. Time in the PACU averages from thirty to ninety minutes.
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16. Will someone be with me during the entire
procedure?
Yes, a member of the Anesthesia Care team (either the anesthesiologist or the CRNA) will be with you throughout the operation. The anesthesiologist will be present or immediately available at all times. Please see question #24 for more information.
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17. How will my vital signs be monitored during
the procedure?
Your anesthesiologist will decide, based on your health and the complexity of the operation, what to use to monitor your vital signs while you are undergoing anesthesia. At minimum, your blood pressure will be monitored with a BP cuff, your heart will be monitored with an EKG, and the oxygen content of your blood will be monitored with a pulse oximeter. Patients undergoing more complex operations or those who have multiple medical problems may require more sophisticated, invasive monitors such as arterial lines, central venous lines or pulmonary artery catheters. Trans-esophageal echocardiography may be used on patients will sick hearts. Again, your anesthesiologist will discuss these monitors with you.
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18. Will I have nausea and/or vomiting after the
procedure?
Nausea and vomiting are two of the more common unpleasant side effects of anesthesia. Nausea and vomiting are also more common after particular operations such as sinus or nose surgery, intra-abdominal surgery, and breast surgery. Certain groups of people are at higher risk for N/V after anesthesia. Young female patients are one of these high risk groups. For those groups of people in high risk groups or those people undergoing high risk procedures, a regiment of pre-treatment with anti-nausea medications along with intra-operative anti-nausea medications decreases the risks of N/V post-operatively.
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19. How will my pain be controlled during and
after surgery?
One or a combination of techniques may be used to control your pain during surgery and after surgery. If you undergo general anesthesia, the anesthetic medicine itself has analgesic (pain blocking) properties. If you undergo spinal anesthesia, the medicine used for the block acts as an analgesic (pain blocker). Narcotic and non-narcotic pain medicines may be given during or after your operation, to help ease your pain. Epidurals may be used for pain control after certain operations, including those that involve chest incisions or upper abdominal incisions. Your anesthesiologist can answer any questions you have about your pain control prior to your surgery.
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20. How long will I be in the “Recovery Room”?
The time you spend in the “recovery room” or Post Anesthesia
Care Unit (PACU) varies with the patient, the anesthetic and the
operation itself. You are in the recovery room long enough to make
sure you have recovered from the anesthetic to the point you are
good and awake, your pain is reasonably controlled, and your vital
signs are stable. Nausea or vomiting should also be controlled prior
to your discharge from the PACU.
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21. Will I have to stay in the hospital after surgery?
More and more operations are being done as outpatient
procedures. We are continuing to find less invasive ways to complete
procedures so that patients can safely recuperate in the comfort of
their own home. There are still many operations that require you to
be admitted for the operation because of special postoperative care
or observation. This extra care may be the result of the operation
itself or because of medical problems the patient has. For example,
patients with sleep apnea may require admission after an operation
that someone without sleep apnea could safely be discharged home on
the day of surgery. In extreme cases, patients may be admitted into
the ICU postoperatively, where they can receive even more
specialized care.
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22. How soon will I be able to drink or eat after my procedure?
The time before you can eat or drink varies in time according
to the kind of anesthesia you received, the length of the
anesthetic, your personal responses or reaction to anesthesia, and
the operation itself. For an outpatient procedure that requires only
minimal sedation with local anesthesia, you may be eating and
drinking prior to leaving without any problems. For an outpatient
procedure such as a knee surgery where you were asleep for some
time, you should be able to tolerate liquids and clears prior to
discharge but you may stimulate nausea and vomiting if you have a
heavy meal immediately after leaving. In some cases, such as
operations that are in or around the abdomen, your stomach and
intestines may be stunned and it may be several days before you will
be able to tolerate liquids or solids. In this case it is a result
of the operation and not secondary to the anesthesia. Lastly, every
person has varying susceptibility to nausea and vomiting post
operatively. If you have a history of post operative nausea and
vomiting, please tell your anesthesiologist. There are several
things that he or she can do to decrease the chances of you being
sick after surgery. In any case, it would be wise to eat lightly at
first to make sure your stomach is up to tolerating food.
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23. What are my options for pain control during labor?
There are several options for controlling or mediating the
pain of labor. Multiple non- or minimally-invasive techniques such
as deep breathing, meditation, visualization or massage that mediate
labor pain are available. These techniques can be discussed in
detail with your obstetrician, midwife or nurse. Another option is
the use of IV narcotic pain medicines (for example, Demerol or
Stadol). This is a minimally invasive technique since you will
already have an IV started on your arrival but narcotics give a
varying degree of relief from the pain of labor. The main limiting
factor for these medicines is their effect on your breathing and the
babies breathing after delivery. Since the medicine is given into
your vein and circulates in your blood, the baby will receive some
of this medicine across the placenta. Some narcotic pain medicine is
safe for you and your baby; a lot is not.
The third option is what is called an “epidural”. An
“epidural” is a catheter that is placed in your back into the
“epidural” space surrounding your spinal cord by one of the
anesthesiologists. Medicine is given through the catheter which
numbs the nerves that go to your stomach, back and bottom. The
nerves to your legs come out near this same area so patients well
often have numb and/or heavy legs as well. The goal for pain relief
with an epidural is around 75-90% - in other words to make the labor
pain manageable or tolerable. Epidurals are more invasive plus they
can have side effects and risks also. The most common, but still
rare, problems include clinically significant drops in blood
pressure, bleeding, nerve injury, and headaches. The placement,
benefits, side effects and risks of epidurals are covered in detail
in our “Epidural Consent” DVD you will see on your admission
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24. Who will take care of me during my surgery/procedure and
afterwards in the Recovery Room?
Because there are medical risks involved any time a patient
undergoes anesthesia, we utilize a team of anesthesia specialists,
which always includes an anesthesiologist and usually includes a
nurse anesthetist as well to care for you. Most of our patients are
cared for with the “Care Team” method of an
anesthesiologist/certified registered nurse anesthetist (“CRNA”)
team although, in some circumstances, our patients are cared for
solely by an anesthesiologist. In either case, there will be an
anesthesiologist and/or CRNA with you during the entire time of your
procedure.
After your procedure is completed, you will transported by the
anesthesiologist/CRNA to the Post-Anesthesia Care Unit (PACU or
“Recovery Room”) where you will be cared for by nurses specially
trained in post-anesthesia care. The anesthesiologist is also
immediately available for your care during this period as well.
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25. Who will be my anesthesiologist?
Your anesthesiologist will be one of the members of
Anesthesia Consultants Medical Group (ACMG) who are all physicians
licensed in the state of Alabama. An anesthesiologist is a
specialist in Perioperative Medicine who is involved in the care of
a patient prior to, during and after surgery. This includes
evaluating and preparing a patient to undergo the stress of surgery,
formulating an anesthetic plan, and then caring for the patient
during the surgical procedure, often in conjunction with a CRNA.
He/she monitors the patient's blood pressure, heart rate, breathing,
and level of consciousness and analgesia as well as adjusting other
parameters to provide a safe, pain-free surgical experience for the
patient. After the surgery, the anesthesiologist continues to
provide the care necessary to ensure a smooth emergence from the
anesthetic and pain control in the Post-Anesthesia Care Unit
(“Recovery Room”)
Becoming an Anesthesiologist requires many years of education. After
four years in college to earn an undergraduate degree, four years of
medical school are necessary to earn a Doctor of Medicine degree.
He/she must then complete another four years of training in an
accredited Anesthesia Residency Program. The physician may then
complete another one or two years in a subspecialty of anesthesia
such as Obstetrical Anesthesia, Cardiac Anesthesia, Pediatric
Anesthesia, or Pain Management. All our physicians are board
certified/board eligible anesthesiologists through the American
Board of Anesthesiology (ABA).
An anesthesiologist is a physician just like your surgeon or
internist. As such, you may receive a bill for the professional
services of the anesthesiologist that is separate from the hospital
bill. If you have any questions about your bill, please
contact our
business office.
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